Gaining the upper hand on pharmacy benefit fraud, waste and abuse

The National Health Care Anti-Fraud Association estimates that the U.S. health care system loses tens of billions of dollars every year to fraud, waste and abuse (FWA). A large portion of these costs are attributed to pharmacy spend, including duplicate claims, data entry errors, forged prescriptions and intentional overcharging.

Pharmacy FWA can result in misused benefits, safety issues among plan members and unnecessary financial losses for employers and plan members. Even more, policy and regulation changes during the pandemic, such as expanded access to telehealth and waived prescription refill limits, have created new avenues for fraudulent activity. So how can plan sponsors protect their members from these risks?

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MORE ABOUT Carrie Aiken

As Chief Administrative Officer, Carrie provides active leadership and support for the organization’s Human Resources, Corporate Compliance, Information Governance, and Fraud Programs.
In this role, Carrie is accountable for day-to-day implementation, performance and maintenance of company processes and controls.
Carrie has more than 25 years of experience across several health care disciplines, including physician, hospital, home health, and pharmacy, as well as contracting and revenue cycle. She has been involved with HIPAA since the inception of the privacy and security rules.